CMS star ratings: A 5-step action plan for hospitals with poor quality rankings

Photo of hand holding a pen writing the word quality

The Centers for Medicare & Medicaid Services has delayed its release of its quality rankings for hospitals, but organizations that expect to receive only one or two stars on the agency’s five-star overall scale may want to come up with a communication plan now.

CMS was supposed to release the rankings in April but held off after industry leaders and lawmakers complained that the data didn’t take into account hospitals that treat patients with low socioeconomic status or multiple complex chronic conditions. The agency said at the time that it would delay the release until July but this morning a CMS spokeswoman told FierceHealthcare that it has not yet determined an exact date for the release.

Picture of David Green from Jarrard Phillips Cate & Hancock, Inc.The star-rating system is meant to help consumers identify hospitals that offer high-quality care and best outcomes. But it also could be a public relations nightmare for hospitals that don’t earn top rankings. To help hospitals come up with a communication plan after the eventual release of the scores, FierceHealthcare recently spoke to David Green, pictured, vice president at Jarrard Phillips Cate & Hancock, a strategic communications and engagement firm for healthcare providers that has offices in Nashville and Chicago.

Step 1: Provide a realistic picture about quality efforts within the organization and ranking systems in general.

“The most important thing for a hospital or health system is to communicate, even if the ratings aren’t strong, that the organization embraces quality and transparency,” Green said.

It’s also wise to frame the discussion with the fact that there are different rating systems used by carious groups and all use different criteria. There is no perfect rating system, he said, and hospitals with less than stellar ratings should point out that many in the industry have concerns about the federal data. “That needs to be explained, internally and externally,” Green said. “I don’t think the tone should be excuse making but the tone should be a realistic look at the ratings, that there are a number of things people can question and none of the rating systems give the whole quality picture.”

The main message is also to make sure that the news of poor ratings doesn’t obscure the good work that goes on at the hospital or health system and that leaders acknowledge the hard work of employees and identify successes that are taking place, according to Green. “Show the institution’s commitment to quality and what will be happening,” he said.

Step 2: Make sure to communicate the message to employees first before the news is made public

The news can also discourage clinicians so Green advises healthcare leaders to communicate the findings with employees first, before they read about it in the news.

“For clinicians who work hard every day and are really dedicated to providing good quality care--the reason most get in the business--it’s very difficult to deal with news that some outside party has a less positive view of performance,” he said.

Healthcare leaders must acknowledge the problem but then celebrate the successes that are happening throughout the organization. “I think it goes back to the affirmation of your belief in quality and transparency and communicating to your employees and physicians what is going on within the organization currently in regards to quality and your plans to improve quality,” he said.

Step 3: If possible, communicate the message in person

“In person communication is usually more effective than written communication,” he said. “I know I respond better when I’m hearing news from somebody in person so that I can ask some questions and look at the speaker.” However, it may be difficult for hospital leaders to see every person within the organization so it’s a good idea to have multiple channels for communication, he said.

Step 4: Make sure communication about quality continues

Don’t make the communication about a particular, isolated event, Green advises. Make sure discussions are ongoing and keep staff informed about ongoing quality efforts. He also suggests that organizations explain how quality initiatives fit within the organization’s greater vision and mission.

Step 5: Educate journalists about quality and rankings

While it may be uncomfortable to answer media questions, Green suggests that hospital leaders use this opportunity to educate journalists about quality and set it in the larger picture. Explain that this is one data point for a complicated issue, and no one has a solution that will improve quality to the ultimate level overnight. Communicate about the quality efforts happening now within the organization and in the future. “Explain that it’s a journey, improving quality is a process of continual improvement and CMS is on that journey too…They are dealing with a set of data and the best way to present it to the public. It’s worth pointing out the limitations of the data, not in an attempt to villainize CMS but to explain that it is a tough job to find the right data that accurately presents a picture of quality,” Green said.

And, he said, be willing to answer questions. “Recognize that communication about quality is going to happen whether your hospital or health system chooses to engage or not,” he said. “Patients share their experiences in social media, coffee shops and soccer games. So it makes sense for hospitals and healthcare organizations to be part of those conversations. If not, they’ll happen anyway.”

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